In the Next Sections, Please Note the Items You D Like to Donate And/Or Will. Check Item

Name
Address
City / State / Zip
(Phone: Home) / (Phone: Cellular)
Email Address
Chapter of Initiation / Year of Initiation
Current Chapter Affiliation

In the next sections, please note the items you’d like to donate and/or will. Check item and choose quantity.

PARAPHERNALIA
Clothing Items
Letterman’s Jacket Qty 12345 / Letterman’s Sweater Qty 12345 / Crossing Jacket Qty 12345
Other Clothing Items Qty 12345 Describe:
Other Clothing Items Qty 12345 Describe:
Crossing Items
Paddles Qty 12345 / Bricks Qty 12345 / Pledge Books Qty 12345
Other Crossing Items Qty 12345 Describe:
Other Crossing Items Qty 12345 Describe:
Jewelry (Personal)
Rings Qty 12345 / Watches Qty 12345 / Charms Qty 12345
Other Personal Jewelry Qty 12345 Describe:
Other Personal Jewelry Qty 12345 Describe:
PARAPHERNALIA (continued)
Jewelry (Issued by Fraternity)
Life Membership Pin
Qty 12345 / Fraternity Badge
Qty 12345 / 25-Year Pin
Qty 12345 / 50-Year Pin
Qty 12345
Other Fraternity-Issued Jewelry Qty 12345 Describe:
Other Fraternity-Issued Jewelry Qty 12345 Describe:
Fraternity Issued Insignia
Polemarch’s Badge Qty 12345
Other Insignia Qty 12345 Describe:
Other Insignia Qty 12345 Describe:
DOCUMENTS
Initiation Certificate Qty 12345 / Grand Chapter Award Certificate Qty 12345
Photographs Qty 12345 Describe
Fraternity Publications (i.e.,“The Story of Kappa Alpha Psi”, “Crossing the Jordan and Beyond”, “The 1928 Handbook of Kappa Alpha Psi”, “The Scroller’s / MOIP Manual”, Constitution & Statutes, “The Journal”, “The Confidential Bulletin”, etc.) Qty 12345
Describe
Esoteric Materials (i.e., copies of The Creed, The Ritual, etc.) Qty 12345
Describe
Other Documents Qty 12345 Describe:
Other Documents Qty 12345 Describe:
DESIGNATION FOR ITEMS TO BE DONATED AND/OR WILLED
Please indicate below your designation for the items listed in the previous sections: (use the drop down list below):
I would like to DonateWillDonate & Will the items listed above
If donation is chosen, please list who the items should be donated to.
You may choose one or more designations from the drop down lists below. If more than one selection is made, describe which items each designee should get:
NoneGrand ChapterNCPCurrent Chapter AffiliationPledge ChapterLegacy
Describe Items
NoneGrand ChapterNCPCurrent Chapter AffiliationPledge ChapterLegacy
Describe Items
NoneGrand ChapterNCPCurrent Chapter AffiliationPledge ChapterLegacy
Describe Items
NoneGrand ChapterNCPCurrent Chapter AffiliationPledge ChapterLegacy
Describe Items
If will is chosen, please list below who the items are being willed to:
Name
Address
City / State / Zip
(Phone: Home) / (Phone: Cellular)
Email Address
EMERGENCY CONTACT
Name
Address
City / State / Zip
(Phone: Home) / (Phone: Cellular)
Email Address
HISTORIAN RECOVERING ITEM(S)
Name
Chapter / Province
Date Item(s) Recovered
Location Where Item(s) are Stored

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